Intraoperative assessment of the dorso-ulnar fragment stability with stress fluoroscopy: An observational study.

This study aims to investigate the effectiveness of intraoperative stress radiographs in evaluating the stability and fixation adequacy of the dorso-ulnar fragment (DUF) after volar plate application. Sixty-four patients who underwent open reduction and internal fixation due to comminuted distal radius fracture accompanied by DUF between May 2020 and February 2022 were reviewed retrospectively. Two groups were compared, with and without stress radiographs used in addition to routine fluoroscopic imaging during the surgical treatment of distal radius fractures. DUF sizes and fracture classifications were made according to preoperative computed tomography. Displacement of the DUF, dorsal cortex screw penetration, and the number of screws inserted into the DUF were evaluated on immediate postoperative CT scans and direct radiographs. DUF displacement at the patients' last follow-up was significantly higher in the control group (1.62 mm) than in the additional stress fluoroscopy applied group (0.53 mm). It was observed that the amount of displacement increased as the dorso-volar size of the DUF decreased. No significant difference was observed in dorsal cortex screw penetrations between the 2 groups. In the additional stress fluoroscopy applied group, stabilization rates with at least 1 screw over volar-locking plate for DUF were significantly higher (P < .001). Compared to the stress fluoroscopy group, the change in ulnar variance (P < .001) and volar tilt (P < .001) was significantly higher in the control group in the last follow-up radiography. No significant difference was observed between the implant removal rates of both groups. Evaluation of the stability of the DUF with stress radiographs after fixation is an effective method to reveal the need for additional fixation. Dorsal stress radiographs allow dynamic evaluation of fixation strength.

Stable elastic nail application with poller K-wire for Irreducible distal radius metaphyseal-diaphyseal Junction fractures in preadolescents: a new operative technique.

BACKGROUND: Surgical treatment of irreducible distal radius diaphyseal- metaphyseal junction fractures involves difficulties as the fracture remains too proximal for K-wire fixation and too distal for the elastic stable intramedullary nail. Our study aims to present the clinical results of applying an elastic stable intramedullary nail with a poller K-wire to achieve both reduction and stable fixation. PATIENTS AND METHODS: A retrospective analysis was performed on 26 patients who underwent ESIN with a poller K-wire for distal radius diaphyseal-metaphyseal region fracture. Reduction parameters such as residual angulation and alignment were evaluated on postoperative follow-up radiographs. Changes in angular and alignment parameters on follow-up radiographs were recorded. Wrist and forearm functions were evaluated at the last follow-up. RESULT: There were 17 male and nine female patients with an average age of 10.9. The residual angulation in coronal and sagittal planes on immediate postoperative radiographs was 4.0 ± 1.62° and 3.0 ± 1.26°, respectively. The mean translation rate on immediate postoperative radiographs was 6.0 ± 1.98% and 5.0 ± 2.02% in the coronal and sagittal planes, respectively. No change was observed in translation rates in the last follow-ups. The mean angulation in the coronal and sagittal planes measured on 6th-week radiographs was 4.0 ± 1.72°and 3.0 ± 1.16°, respectively. No significant difference was observed in angular changes in the sagittal and coronal planes at the last follow-up (p > 0.05). No tendon injury or neurovascular injury was observed in any of the patients. CONCLUSION: In the surgical treatment of pediatric DRDMJ fractures, applying ESIN with poller K-wire is an effective, safe, and novel method for achieving reduction and stable fixation.

Implementing an infection control checklist May not be effective in reducing the incidence of surgical site infections in spinal surgery.

Background: Surgical site infections (SSI) in instrumented spine surgery remains as a major complication with increased morbidity. Although implementation of surgical safety checklists has been reported to lower the rates of SSI, reproducibility of these remain unclear. Objective: The specific aim of this study was to explore the results of implementation of a SSI control protocol in regard to its efficacy in decreasing the rate of SSI. Methods: A total of 140 instrumented spinal surgery cases between 2018 and 2021 were divided into two groups as Group 1 (checklist implemented) and Group 2 (control) and these were compared regarding SSI rates, patient rand surgery related factors, laboratory findings and infecting microorganisms. Results: Ten SSIs were encountered in Group 1 (20.8%), whereas only nine in Group 2 (9.8%). Although not statistically significant (p > .05), these results highly favor the non-checklist implemented group regarding the development of SSI. A definitive infective microorganism could be identified in five out of 10 SSI in Group 1 and 6 out of nine in Group 2. Whereas only three out of 11 (27.3%) involved Gr (+) agents, rest of eight out of 11 (72.7%) involved Gr (-) agents. Discussion: A failure in decreasing the SSI rate through the implementation of a SSI prevention checklist may be due to several factors pertaining to the study design, patient characteristics and the Gr (-) dominance in SSIs in our center. Nevertheless, this suggests that checklist implementation to prevent SSI in instrumented spine surgery may not be effective in all contexts.

A Novel Technique for Labral Reconstruction Using Long Head of Biceps Tendon: Duru Technique.

Arthroscopic capsulolabral repair is a well-established surgical treatment for traumatic anterior shoulder instability. When there is insufficient labral tissue during arthroscopic primary or revision Bankart repairs, various soft tissue procedures have been recommended. All these procedures aim to reattach glenohumeral ligaments to the glenoid rim and regain the tight anterior structures to prevent re-dislocation or subluxation. Some authors recommend the Latarjet procedure, even in the absence of critical bone loss in this patient group. The labrum increases the depth of the glenoid cavity, thereby, increasing the glenoid track. It behaves like a block for the humeral head. Reconstruction of the labral tissue may strongly contribute to shoulder joint stability when it is totally absent. In this article, we describe a novel labral reconstruction technique (Duru technique) using the long head of the biceps tendon in two patients without an existing labral tissue.

Is a Unilateral Surgical Approach Effective in Patients with Bilateral Leg Pain with Unilateral Lumbar Disc Herniation? A Prospective Nonrandomized Clinical and Surgical Study.

OBJECTIVE: To examine the surgical results of unilateral lumbar discectomy in patients with bilateral leg pain and discuss short- and long-term outcomes within the limits of lumbar decompression. METHODS: We analyzed 60 patients with unilateral disc herniation who underwent unilateral lumbar discectomy and hemipartial laminectomy between 2014 and 2017. Group 1 (30 patients) had bilateral leg pain and unilateral lumbar disc herniation. Pain lateralization was determined radiologically. Group 2 (30 patients) had unilateral leg pain and unilateral lumbar disc herniation. Pain scores were preoperatively evaluated with visual analog scale (VAS) for both legs and Oswestry Disability Index (ODI) for overall life quality. In both groups, surgery was performed on the ipsilateral side of the herniated disc. Scores were repeated on postoperative day 1 and 1, 3, 6, 12, and 24 months later. VAS score differences for pain lateralization and disc levels were compared in group 1. ODI score differences were compared between both groups. Results were statistically analyzed. RESULTS: VAS score differences were statistically significant at all follow-up time points in patients with ipsilateral and contralateral pain. VAS score differences between L4-L5 and L5-S1 level discopathies were statistically insignificant for all time points in both groups. All postoperative ODI score decreases for all time points were statistically significant (P < 0.001) for both groups, whereas the differences between groups 1 and 2 were statistically insignificant. CONCLUSIONS: Conventional lumbar disc surgery alone is sufficient for the ipsilateral side of radiologically demonstrated disc herniation in patients with bilateral leg pain.

Adult acetabulo - pelvic parameters in Turkish society: A descriptive radiological study.

OBJECTIVE: The aim of this study was to measure the prevalences of the acetabular index, collodiaphyseal angle, CE angle, articulo-trochanteric distance, cross-over sign and posterior wall sign in healthy Turkish people, in order to shed light on the production of orthopedic medical products. METHODS: In this study, both hips (a total of 3960 hips) of 1980 individuals (1178 males, 802 females) from nine different cities between the ages of 18 and 65 years were measured and statistically analyzed. RESULTS: The right articulo-trochanteric distance of all participants was 19.67 ± 4.52 mm and the left articulo-trochanteric distance was 19.10 ± 4.58 mm. The CE angle was 35.11°±7.41° in the right hip and 35.37°±6.76° in the left hip. The acetabular index was 37.58°±5.30° in the right hip and 37.80°±4.82° in the left hip. The collodiaphyseal angle was 138.60°±8.27° in the right and 137.84°±8.01° in the left hip. The prevalence of cross-over sign in the right hip was 6.46% and 6.66% for the left hip. The prevalence of posterior wall sign was 4.24% for the right hip and 4.19% for the left hip. CONCLUSION: This study has provided prevalence values of cross-over sign, posterior wall sign, acetabular index, collodiaphyseal angle, CE angle and articulo-trochanteric distances of a healthy Turkish population between the ages of 18 and 65 years.